Paste your essay in here…Introduction
Drug legalisation is a very controversial subject, but one that is beginning to be approached in mainstream politics. The debate is dominated by hard-line positions: those calling for legalisation or decriminalisation, such as the Transform campaign (Transform Drug Policy Foundation, n.d.); and those in support of the ‘war on drugs’ characterised by drug policy which criminalises drug manufacture, sale, possession and use – still present in the UK (Home Office, 2017). Research into the impact of current and potential drug policies is surely needed yet is hampered by political and ethical barriers and lobbying by pharmaceutical companies and anti-drug campaigns. The same evidence of drug use rates, death rates and pharmacological data is being interpreted in different ways by the opposing sides of a debate, characterised by emotionally manipulative rhetoric and misinformation. It is surely necessary to examine the risks and benefits of recreational drug use on public health and to compare these with the effects of legal drugs such as alcohol. And in a society where the cost of healthcare continues to escalate, the economic benefits of legalising recreational drugs cannot continue to be ignored.
Essay
The main point of debate on drug policy should surely be harm reduction and there is evidence for both sides in this case – however, it is the lack of extensive trials on the harms and potential benefits of illicit drugs as a result of their legal status that turns the debate ideological i.e. socially liberal or conservative. The few examples of legalisation or decriminalisation that exist globally have been used to support both opposing arguments – the blanket decriminalisation of drugs in Portugal has been referred to both as a “resounding success” (Greenwald, 2009) and as having simply “not worked” (Rickman, 2012), for example. This goes to illustrate the difficulty of finding balanced and objective perspectives on the debate beyond raw data from scientific studies, and therefore illustrates how suboptimal drug policy has been preserved by stagnant, unconstructive debate. The fact that Portugal is considered by some to have been unsuccessful in light of clearly falling drug deaths shows how such a deadlock had come about in the debate – some anti-drug campaigners are unwilling to accept evidence on the subject. Therefore, it has become the case that drug policy is no longer, if it ever was, formed in the best interest of public health; rather as a means of winning over voters, supported by cherry-picking evidence from the limited number of small-scale trials conducted.
One particular problem with the polarised debate on drugs is the ensuing dishonest misrepresentation of research findings by both sides. Conservatives can be accused of hypocrisy – few are calling for criminalisation of alcohol or tobacco, yet liberals can be accused of disregard for the evidence of the harm some drugs can cause. In some instances, both of these are true: pro-legalisation campaigns often downplay or ignore findings suggesting potential harm, and anti-drug groups will exaggerate or infer links between drugs and harm. Norml, “the world’s oldest and largest cannabis reform lobby group” (Norml UK, n.d.) suggests that claims of a link between cannabis and mental illness are unfounded (Bovey, 2013), while studies have drawn clear links between cannabis use and short-term psychotic reactions as well as bringing on schizophrenia for those genetically pre-disposed to it (Leweke, Gerth, & Klosterkötter, 2004). However, this Norml article was in response to an equally hyperbolic Telegraph article, which claimed skunk cannabis now contains up to 46% THC (the main psychoactive compound in cannabis) despite the referenced study specifying the important detail that this 46% only occurred as a result of refinement by users, rather than significantly more powerful strains of cannabis as the article suggests, a detail conveniently absent from the Telegraph report. Sometimes, the problem can even arise from the same data – while Portugal’s decriminalisation program is largely considered a success in reducing drug related deaths and drug related crime (Greenwald, 2009), Dr Manuel Pinto Coelho of Drug Free Portugal says, “It makes no sense that people say since decriminalisation drugs use fell in Portugal” and cited White House statistics that appear to show an increase in drug related deaths during 2004-2006 in Portugal (Rickman, 2012). These contradictions, that occur as a result of biased interpretation of evidence, muddy the water as to what the actual public health implications of different policy implementation would be and reveal yet again that both sides are willing to distort the truth of the dangers and benefits of drug policies in order to fit their ideological motives and pre-conceived opinions. To take the example of the Telegraph’s report, there are two possible explanations for the misrepresentation of scientific findings: 1) the author understood the actual meaning of the findings and deliberately exaggerated them; or 2) the author did not take the time to fully understand the findings and genuinely misunderstood their meaning. Either possibility displays entering research with a preconception and seeking evidence to support it, leading to lack of objectivity in its conclusions, inhibiting its ability to offer a true assessment of the costs and benefits of a position on drug policy.
Perhaps the most significant indicator in suggesting political positions on drugs do not prioritise public health is the discrepancy between the treatments of illegal psychoactive substances and those substances which have historically been legal and culturally accepted. To explore this, the examples of alcohol, as legal, and MDMA, as illegal, can be compared in terms of safety. In England and Wales, between 1.2 and 2.1% of people aged 16-59 said to have used ecstasy in the last 12 months during 1993-2016 and deaths where ecstasy was mentioned on the death certificate ranged from 8-58 per year during this period (Manders, 2017). In the worst year for ecstasy deaths in the UK, 2005, there was 1.6% use (Manders, 2017), in a 16-59 population of 36.1 million (Barrow, 2014), meaning approximately 577,600 people used ecstasy at some point that year, and yet only 58 died as a result (Manders, 2017), meaning approximately 0.01% of people who took ecstasy died in that year with ecstasy mentioned on the death certificate. This is a worst-case scenario, assuming any certificate mentioning ecstasy meant death as a result of ecstasy and is based on the worst year on record for ecstasy deaths. Despite this, the death statistics for legal drug alcohol were significantly worse in the same year: there were 15.2 alcohol related deaths per 100,000 people (Campbell, 2017), or approximately 9813 deaths (15.2×60,413,300/100,000 = 9813) which in the section of the 2005 population that drink alcohol (Windsor-Shellard, 2017) equates to approximately 0.02% of those people who drink, dying per year (based on 2005), according to an ONS population estimate (Randall, 2017). That raises the question: why is MDMA not legalised and alcohol banned? The answer lies in the numbers of people that take each drug respectively: in 2005 approximately 60,400,000 drank alcohol, approximately 550,000 took MDMA. As “Ultimately, democracy is the process of aggregating preferences revealed as votes” (Issacharoff, 2008), governments will generally take the position that they believe will please the most people in order to remain in power. While of course there is no certainty that MDMA is safer than alcohol, the fact that this is not being extensively trialled reveals the priorities of politicians with regard to drug policy – notably that the importance of mass popularity exceeds that of public health. The importance in democracy of short-term popular decisions outweighs the risks associated with relaxing drug laws: conservative voters will be put off initially and any positive result will take too long to be proven, and this deprioritises serious drug law reform for governments, even if they support the idea in theory. Furthermore, even if change is currently prevented by public opinion, the long-term nature of any government action would make it an unattractive option politically anyway, making any action directed from those in political power unlikely.
Similarly to government actions, the actions of the media often also revolve around the short-term popular gain that can be achieved by demonising drug use, without regard for what is best for public health. For instance, the BBC produced a documentary called ‘One night of ecstasy’ detailing the death of a British teenager as a result of ecstasy pills. This documentary is significantly differently presented to the BBC documentary about alcohol ‘The Truth About Alcohol’, which is more objective and factual, and less emotive, because of the different nature of deaths caused by the drugs. The ecstasy death portrayed in the documentary is a freak incident in which a young person died suddenly, while the alcohol documentary looks at long-term effects, and weighs them up against the benefits of alcohol. This difference in approach implies safety using ecstasy can only be achieved by abstinence, and therefore illegality, where in fact risks could be greatly reduced by regulation of ecstasy and dosage guidelines (which, not incidentally, are the same precautions applied to alcohol). Material created to deter MDMA consumption appears to have had little effect, in fact MDMA is one of the few illicit recreational drugs that has not seen significant decline in recent years in the UK (European Monitoring Centre for Drugs and Drug Addiction, 2017). The decision of media to deter and demonise drugs entirely rather than detail safe use is surely one made to protect popularity, not one to improve public health – the shock factor of drug overdose deaths can be used to justify current drug policy by emotional manipulation of the public without revealing the reason for the deaths. The example in ‘One Night of Ecstasy’ was a death as a result of taking two untested pills in conjunction with heavy drinking: this could have been prevented if drug messages made clear the risks of unsafe use while explaning safe use i.e. testing pills, not mixing MDMA with depressants like alcohol, and starting by taking half a pill. Therefore, to use this tragic case to simply deter use is to disregard why it happened in the first place, and yet another example of the anti-drug campaign prioritising emotive material to garner popularity over the interests of public health.
Unfortunately, an area of recreational drug policy decision-making seldom explored is that of potential benefits rather simply minimising of harm – these benefits are twofold. Firstly, safe and moderate recreational drug use can improve human mental and social wellbeing. Despite research on illicit substances being plagued with regulation, studies on alcohol can still illustrate this. Moderate alcohol consumption has been shown to have positive social effects, such as “as a means of servicing and reinforcing social bonds” (Dunbar, et al., 2017), so that “social drinkers have more friends on whom they can depend for emotional and other support, and feel more engaged with, and trusting of, their local community” (Dunbar, et al., 2017) and there is no reason to suggest that in the event of legalisation this would not be extended to social users of other drugs. MDMA (ecstasy) produces feelings of “emotional communion, oneness, relatedness, emotional openness” (Colman, 2015), something that should be valued in a society where some human interaction to technological communication. This is further supported by a comparison of the recorded effects of different recreational drugs. According to FRANK, alcohol’s main two effects are “reduced feelings of anxiety and inhibitions, which can help you feel more sociable” and “an exaggeration of whatever mood you're in when you start drinking” (FRANK, n.d.). MDMA’s listed effects are “an energy buzz that makes people feel alert, alive, in tune with their surroundings” and “temporary feelings of love and affection for the people they're with and for the strangers around them” (FRANK, n.d.), which are consistently more conducive to positive social interaction. Because these effects are rarely acknowledged in discussions on drug legislation, it is likely that these potential positives will be ignored because of the taboo of appreciating benefits of recreational drug use. Aside from social benefits of recreational drug use, some currently illegal substances have been shown recently to be very effective as alternative treatments to mental conditions. However, the legal status of these drugs has limited their trial since the 1970s (Drugwise, 2016).
The stagnation of the debate is inhibiting the work of scientists who are providing unbiased evidence through clinical trials, and this is stifling the development of potentially revolutionary treatments. Not only has overly rigid drug legislation slowed down research into the safety of different illicit drugs, it has prevented the discovery of practical medicinal uses of these substances: namely LSD and MDMA. The two most prominent recent trials have been of LSD in treatment for alcoholism, and MDMA-assisted psychotherapy for PTSD. In the LSD trial, a meta-analysis was performed on results from the 1960s and determined that 59% of people who attended the treatment programme and took a dose of LSD had reduced levels of alcohol misuse after six months compared to only 38% in those who did not take LSD (Krebs & Johansen, 2012). Existence of this data for over 40 years, which now has the treatment being described as having “a significant beneficial effect” on treating alcoholism, and “the best thing we’ve got” (Krebs & Johansen, 2012), has not resulted in further development of the treatment, as a result of rigid drug legislation that has remained unchanged for LSD since its recreational ban in 1966 and ban from medicinal use and trial in 1973 under the Misuse of Drugs Act (Drugwise, 2016). While the government tried to protect public health by banning recreational use, the inflexibility of drug laws prevented development of treatments which could have had a significant and direct positive impact on public health. This situation could still be the case for other potentially useful banned substances, and as loosening laws on Class A drugs may not be popular with the general public, this may not change for some time yet. This reasoning is particularly relevant to these trials because they take a long time to complete, a long time to implement into actual treatment, and even longer to see a significant benefit on public health – hence updating these drug laws is not a government priority due to the lag between government action (which will attract negative press from more conservative voters) and any political pay-off in the form of improved public health.
Alongside the political arguments, it is also necessary to explore the economics of legalisation, specifically taxation, and the costs of the criminality spawned by illegal drug use and supply. An argument present in many legalisation campaigns is that money can be removed from the current system of the illegal drug trade, funded by crime, and be used to create jobs and increase tax collection. This is an important consideration, even while looking at the subject from a health-focused perspective as money can be invested back into health. But perhaps even more importantly the economics of the illegal drug trade also impacts public health by fuelling crime, and competition between suppliers to produce the most powerful drugs drives up pill potency. In the 1990s and 2000s, the average ecstasy pill MDMA content was 50-80mg, but is now approximately 125mg on average, with some super pills containing up to 340mg (European Monitoring Centre for Drugs and Drug Addiction, 2016). Drug production must be brought into a regulated system to stop the escalation of drug potency to very dangerous levels, and also allow money from taxation to be invested in health. While this may seem like valuing tax money over public health, the two are not mutually exclusive and using a regulated, taxed system will guarantee safer products for consumers, as well as freeing up money for spending on health and eliminating the risk to the public from drug-related crime. In fact, to fail to acknowledge the economic argument for legalisation is to accept the loss of an estimated £10.7bn per year made by criminals in the drugs trade in the UK alone (National Crime Agency, n.d.), funded by the crimes of addicts and drug gangs which cause further economic damage and risk to public safety. Furthermore, great economic and social damage is being caused around the world as a result of the illegal drugs trade, particularly in areas of drug production, such as Columbia for cocaine. Therefore, from a more globalist perspective, the effects of the illegal drugs trade are even worse and if the UK is to acknowledge its role in allowing this to continue, more moral weight is added to the legalisation argument. If the UK wants to consider itself a country which helps less developed states, it needs to consider the impact of its drug policy and do what it can to stop the illegal flow of drugs from developing countries like heroin from Afghanistan and cocaine from Columbia, and it must look at alternative ways of doing so. If properly produced, controlled legal drugs were available, this would reduce demand for Columbian cocaine or Afghan heroin, offering a more sustainable solution worldwide.
The pro-reform campaign has gathered the support of a number of well-known faces and important figures in the UK, including the former deputy prime minister Nick Clegg and a host of endorsements from celebrities such as Dame Judi Dench, Morgan Freeman and Brad Pitt (Transform Drug Policy Foundation, n.d.). However, media coverage is still limited, probably due to the stigma attached to discussing legalisation or even decriminalisation, and there seems to be little headway being made in government. The real interest lies in the anti-drug lobby: little information is directly available in the public domain regarding the contributions of pharmaceutical companies in the UK, but in the US, it has been discovered that in 2016 the pharmaceutical company Insys was the biggest donor to the anti-legalisation lobby in Arizona, donating $500,000 to the campaign against marijuana legalisation in the state in that year (Stern, 2016). In the UK, the pharmaceutical company Pfizer effectively threatened to withdraw from NHS supply if the NHS did not invest in its version of an Alzheimer’s drug being widely developed at the time (Evans & Boseley, 2006). The National Institute for Clinical Excellence (NICE), which advises the NHS on its drug supply, suggested that the NHS should not invest in Pfizer’s drug on the grounds of its poor efficacy and cost-effectiveness. Following this decision, a special meeting was arranged between ministers and the executives of several drug companies, as they continued to lobby the ministers, before they again rejected the drug on the grounds of NICE’s decision (Evans & Boseley, 2006). Therefore, if the UK was as close to legalising recreational cannabis as the US, it could be well assumed that pharmaceutical companies would have the power – Pfizer’s ability to get private meetings to lobby ministers even after their drug was rejected – and motivation – the actions of Insys in the US – to lobby against legalisation. This is another political situation in which public health implications are not the motive or priority. Though the pharmaceutical companies may cite public health concerns as their reasons, in reality they are more likely motivated by protecting their share of the market in treating conditions cannabis has been seen to have helped, by lobbying health ministers and giving financial support to campaigns.
Finally, there are the pure ideological positions on drug legislation of zero tolerance and libertarianism. By their very nature, these positions are not concerned with the health implications of legislation and will inevitably cause harm. Firstly, zero tolerance – or at least low tolerance – has been employed in the US for drugs. With significant incarceration for possession charges, many drug users are sent to prison. Of course, America’s drug problems continue to escalate, drugs are still sold, and people still take them – they are then just removed from society and cost the state money, even though their drug use could have been stopped or was not posing a significant problem to their health and productivity anyway. As prison is then full of drug addicts and drug dealers, unsurprisingly, people incarcerated on drug charges continue to take drugs after they are released and reoffend. This vicious cycle removes a significant section of society, introduces users to harder drugs and costs the state a huge amount of money in the process. The problem is only escalating – the fact that ‘65 percent of American inmates are clinically addicted to drugs’ (Silver, 2013) and the recent prescription opioid addiction crisis reveal this ideological treatment of drug use to be a fatally flawed system. At the other side of the ideological spectrum, total libertarianism would allow great health damage from drug use too. Unregulated production and consumption of drugs would exaggerate many of the problems that already exist, in terms of dosage, contamination and addiction. Without government regulation, almost all of the benefits of legalisation are removed, and the total free market would drive up potency yet further and increase accessibility to dangerous amounts of stronger, poorly produced substances. Therefore, as the position most beneficial for public health lies somewhere between these two extremes – through accepting the reality of recreational drug use while minimising its damage by regulation – the pure ideological debate is inherently damaging for public health. By its very nature, the absolutist position against recreational drugs is not in the best interest of public health. The ‘war on drugs’, characterised by total criminalisation with the intention to remove consumption entirely is idealistic and unrealistic, failing to achieve its aims, but not giving any help in advising safe use or rehabilitation from addiction. The libertarian argument, on the other hand, applies the logic-based philosophy of John Stuart Mill, that “the only purpose for which power can be rightfully exercised over any member of the community, against his will, is to prevent harm to others” (Mill, 1869). However, this does not necessarily apply to a situation of legalisation – “addiction to, or regular use of, most currently prohibited drugs cannot affect only the person who takes them” (Dalrymple, 1997) – and this renders the ideological argument of human right to free will almost useless in relation to recreational drugs, because drug use certainly can negatively impact others. Therefore, it stands that either extreme of the ideological spectrum applied unpragmatically in drug policy would have detrimental health implications.
Conclusion
In conclusion, much of current UK legislation on recreational drugs does not prioritise the impact of legislation on public health, but rather the fulfilment of an ideological agenda. This has polarised the two sides of the debate, spawning misinformation on the little evidence available, and examples of decriminalisation such as in Portugal. Economic factors point only to legalisation, which would lead to reductions in drug-fuelled crime as seen in Portugal (Greenwald, 2009), and allow tax revenue to be collected as with tobacco and alcohol. There is also clear indication of political self-preservation and the media’s concern of consumer backlash in the way the debate is presented. The emotional shock value of drug deaths is employed as an excuse to deter drug use, while avoiding giving out harm-reducing safe use advice. Current drug policy is showing detrimental effects on public health, through drug problems in prison and the highest UK drug death rates in ONS records (Osborn, 2018). Often, such problems are oversimplified and put down to the evils of drug use and the dangers of the compounds themselves, and this is reinforced by the lobbying of pharmaceutical companies to protect their share of the market. Fundamentally, while there is plentiful evidence in support of drug legalisation, it is often not consulted because of reluctance to discuss it. People’s opinions on drugs are largely formed as a result on personal experiences with drugs or ideological preconceptions and this prevents fair analysis of any evidence that does make it into the public domain. Therefore, in order for drug legislation to suit what is best for public health, the drive must come from ‘the top’ – those in political power – to make the general public aware of the true impacts of drugs so they can make an informed decision on the issue. Only this will finally put health impacts at the top of the agenda for drug laws.